A prospective study on evaluation of maternal and foetal outcomes of hypothyroidism with levothyroxine and prevalence of hypothyroidism in pregnancy in a tertiary care teaching hospital in Kerala

Abstract

Background: Pregnancy influences a profound alteration in thyroid function and hypothyroidism has a massive impact on adverse pregnancy outcomes. An appropriate treatment with appropriate dose of levothyroxine is much essential during pregnancy. The present study evaluates the effect of levothyroxine dose in preventing maternal and foetal outcomes and the prevalence of hypothyroidism among pregnant women.Methods: 1500 antenatal women with singleton gestation attending outpatient of Obstetrics and Gynaecology Department, were analysed. Apart from routine obstetrical investigations, thyroid stimulating hormone (TSH) tests were done at the first antenatal visit. Patients were followed up till delivery after levothyroxine treatment. Their obstetrical and perinatal outcomes were noted. TSH estimation was done 3 days after delivery in new-borns to screen for neonatal thyroid disorders.Results: The prevalence of hypothyroidism was 10.54%. The common adverse maternal and foetal complications were preeclampsia (15.19%) and low birth weight babies (17.72%) respectively. The mean age of pregnant women was 26.66 years. As age advances there is an increased risk of developing hypothyroidism in pregnancy. Levothyroxine 25 μg daily was highly prescribed in 63.92% hypothyroid patients.Conclusions: Overall, the prevalence of hypothyroidism was high. Since maternal and foetal complications were higher in patients with hypothyroidism, levothyroxine treatment had decreased the risk of maternal and foetal outcome. Pre-pregnancy screening should be implemented at least in patients with high risk factors for thyroid dysfunction. Universal screening for new-borns is also recommended to detect hypothyroidism. Expert decisions and cost-effectiveness studies will promulgate the impact of universal screening.